Providers should consider measles in patients with FEVER AND a descending RASH in a person with a history of travel or contact with someone who has travelled outside North America whether or not the patient has had 2 doses of MMR or prior measles disease. However, persons without a history of travel or exposure to a traveler, are unlikely to have measles in the absence of confirmed measles cases in your community.

Symptoms plus risk factors should make providers suspect measles:

Symptoms

Fever, including subjective fever.

Rash that starts on the head and descends.

Usually 1 or 2 of the “3 Cs” – cough, coryza and conjunctivitis.

Risk factors

In the prior 3 weeks: travel outside of North America, transit through U.S. international airports, interaction with foreign visitors, including at a U.S. tourist attraction, or travel to areas of the U.S with ongoing measles transmission.